What it takes to work in an emergency room

Dr. Alan from Family Medical Practice gives readers an inside look at what it takes to work in an emergency room. Photos by Vinh Dao.

In the ER room, you need a certain kind of compassion just as much as a heart of stone. You can’t get attached to death. It’s not colds and flu that we see here, but the real challenging cases—trauma, vehicular crashes, motorcycles, a little violence. Some high-projectile mechanism of injury; like speeding on the road. It’s like this every night—the skies darken and the streetlights flicker to life, while those of us on night shift steel ourselves for another round of trauma, injury, and saving lives.

The worst case I saw here was a drunk tourist who jumped from the 5th floor of a classy hotel. Once he hit the ground, his bone was totally exposed, gushing blood, and squirting—and if a wound is squirting, it must be very, very deep. He was pale, he was still mumbling, but the sounds were incomprehensible. We really needed blood and pain relief. But it was also a hazard for my staff and me, because when there’s so much blood everywhere, we have to protect ourselves. I had to manage all the bystanders as well, all the people who wanted to stop and take photos and then publish them online. If you’re the doctor on site, you’re the first responder, the captain of the ship. You’re responsible for everything.

In the evening, you have to be fast, it has to be “blink and think.” If a patient comes in convulsing, is he having a febrile fever seizure? Is he intoxicated? Did he take isoniazid drugs? You have to diagnose the cases fast, especially in Vietnam where they dispense medicines left and right, where everything is complicated and people don’t know what prescription drugs they’re taking. Then, if the emergency bell rings, you have to drop everything; quickly hand over to your nurse and the backup doctor, get on the ambulance, and just go.

You can’t always tell what’s waiting for you at the end of the ride. Sometimes when an English-speaking patient has an emergency, they ask their driver or someone Vietnamese to call us. But Vietnamese people don’t always like to give so many details over the phone. On one call, the information we received was “someone has stomach pain”. When we got there, we found ourselves having to deliver a baby in the bathroom.

It was about two in the morning. She was British, it was her second child, so she knew the pain. Her water had broken, and she thought she could do it by herself, but of course, the toilet was dirty, and with all the blood spilling out, the baby coming out, and the placenta, how would you get it?

The mother was really submissive. PUSH! The baby popped out, it only took about 20 minutes. That was my first home delivery in Vietnam. Of course, in my home town in the Philippines, we do it a lot, on the floor, everywhere. But here, yes, the baby was well, crying and pinkish; we cut the cord, we delivered the placenta, then we let the mother hold the baby to her breasts to smell the mother’s pheromones for attachment. Then of course we took them to definitive care, all before the sun came up.

There’s a cultural barrier here, a cultural difference. We have to understand how they perceive life in Vietnam. We also have to understand that, when someone dies, we have to sterilize the room, even if the patient died from cancer, something not infectious. People do die in here—not as often as you might imagine, but when it happens, they like to bring relatives back home to rest there. We have to compromise as well. They want to apply some heating oil, some coins, they ask us about this. Part of our job here is to get immersed with the old ways of traditional medicine.

We’re lucky here in Vietnam that we don’t have so many mass casualty incidents. My specialty may be emergency, but in my sub-specialty, I’m really inclined toward disaster medicine. In my home town, we see terrorist activities. There was a policeman who ran amok because he got fired from his job, so he held an entire busload of tourists hostage and then he killed five people. It was a rainy night, and I was just in training at the time, working that night shift. The whole ER was so congested because it was under renovation. Then, boom! Five dead, three critical, and others moaning. You don’t just see the critical cases, you also see the patients from the tear gas, from the blast injury. They have shrapnel, hot glass. The noise, the heat, the pale light of the ER room lamps.

Another mass incident was a bomb blast. Someone had left a bag with explosives outside an examination center. They brought about 30 people into our hospital, and everyone was in pain. Of course, the parents were wailing. There was a young student, first year in college, who lost both of her legs. She was shaking, her blood pressure was going down, and she was asking, “Doctor, I cannot feel my legs”. What could I say? I wanted to turn around and shout for a doctor, but I was the emergency specialist at that time. That’s when it hit home, that realization of the responsibility of my role. Here, we don’t have many incidents like that. That’s very good. But we’re still prepared for them if they occur.

If it’s the middle of the night, and you have an emergency, then do call us. Our number is *9999. We will respond to your calls. House call, road call, hotel call—we will get there with a prepared team. Give us good information, vital, pertinent information. Give us the easiest route to get to where you are. If possible, have someone wait outside your door on the ground floor—for example, so that we don’t get stuck at your elevator without an access card. Meet us, keep your phone line open, be mentally and emotionally strong, because we need that, and your patient needs it too at that moment. Even though it’s late at night, we all need to think sharp.

In an emergency case, if there’s a problem with the airways, breathing, circulation… patients go straight into ER, they get prioritized. It’s going to be very busy during the first few minutes. Nurses are going to be hovering around them. A lot of questions, a lot of activities—like inserting an IV line, doing a chest ECG, administration of oxygen, lights flashing, X-ray—a lot of movement. It’s difficult for the patient and for the family, because they’re anxious already, and they want to get treated. But bear with us. We have to know what’s going on. We have to ask pertinent questions. Other things can be left for the secondary survey, but for the primary survey, there may be a lot of questions—last medicine intake, last food intake, what happened within the past five hours, things like that. ER has to be fast. So bear with us if we ask straight-to-the-point questions, if we seem heartless sometimes. This is our job. We have to save you, we have to do what you’re paying us for, in order to save your life, right?

Our job is to protect people whenever a medical emergency strikes, no matter what time of night it is. We doubled our ambulance fleet recently, and the real beauty in that is more community education. I believe we’re making this community a healthier place, and that people are becoming more aware of their health. *9999 is an ambitious project, I think it’s very courageous. The ambulances may be expensive, but it’s a sacrifice for the community, it’s how we give back. High visibility of medical access. It feels like Saigon will be a safer place to live.